Clinical Schizophrenia and Related Psychoses最新文献

Antipsychotic medications can effectively treat psychotic symptoms in individuals with schizophrenia. However, side effects including cardiovascular and extrapyramidal symptoms are often inevitable. Exercise has proven effective in ameliorating cardiometabolic abnormalities in individuals with schizophrenia. In addition, exercise has consistently been an effective intervention for improving the symptoms associated with schizophrenia. We report here two cases in which individuals with schizoaffective disorder treated with a long-acting injectable antipsychotic medication displayed worsening of extrapyramidal symptoms over the course of a 12-week exercise program. This can be attributed to an increase in blood flow to the depot site during exercise, accelerating the rate of absorption and bioavailability of the antipsychotic medication and subsequently increasing dopamine D ₂ blockade. Clinicians need to be vigilant when patients receiving long-acting injectable antipsychotic medications engage in exercise.

Introduction: Despite growing interest in smartphone apps for schizophrenia, little is known about how these apps are utilized in the real world. Understanding how app users are engaging with these tools outside of the confines of traditional clinical studies offers an important information on who is most likely to use apps and what type of data they are willing to share.

Methods: The Schizophrenia and Related Disorders Alliance of America, in partnership with Self Care Catalyst, has created a smartphone app for schizophrenia that is free and publically available on both Apple iTunes and Google Android Play stores. We analyzed user engagement data from this app across its medication tracking, mood tracking, and symptom tracking features from August 16 ^th 2015 to January 1 ^st 2017 using the R programming language. We included all registered app users in our analysis with reported ages less than 100.

Results: We analyzed a total of 43,451 mood, medication and symptom entries from 622 registered users, and excluded a single patient with a reported age of 114. Seventy one percent of the 622 users tried the mood-tracking feature at least once, 49% the symptom tracking feature, and 36% the medication-tracking feature. The mean number of uses of the mood feature was two, the symptom feature 10, and the medication feature 14. However, a small subset of users were very engaged with the app and the top 10 users for each feature accounted for 35% or greater of all entries for that feature. We find that user engagement follows a power law distribution for each feature, and this fit was largely invariant when stratifying for age or gender.

Discussion: Engagement with this app for schizophrenia was overall low, but similar to prior naturalistic studies for mental health app use in other diseases. The low rate of engagement in naturalistic settings, compared to higher rates of use in clinical studies, suggests the importance of clinical involvement as one factor in driving engagement for mental health apps. Power law relationships suggest strongly skewed user engagement, with a small subset of users accounting for the majority of substantial engagements. There is a need for further research on app engagement in schizophrenia.

Background: Suicide mortality is 12 times higher in psychotic patients compared to the general population. Identifying characteristic of suicidal patients among this group might help in preventing such behavior.

Aims: To assess the predictors of suicidal risk in patients hospitalized due to acute psychosis.

Methods: One hundred and fifty patients (age 18 - 60 years) admitted with acute psychotic features were recruited. Patients were evaluated clinically by The Arabic version of Mini International Neuropsychiatric Interview (M.I.N.I.). Suicidal ideation was assessed using the Scale for Suicide Ideation (SSI).

Results: Forty four out of 150 patients (29.33%) reported having current and/or previous history of suicidal ideation. Patients with major depression showed the highest suicidal tendencies followed by delusional disorder then bipolar disorder, psychosis related to substance abuse and schizophrenia. The more severe the psychotic symptoms, the more suicidal tendencies shown by patients. Predictors for suicidal ideations included diagnostic category, severity of psychotic features, unemployement and younger age CONCLUSION: Patients with psychosis that require admission to the hospital carry a high risk of suicidal ideation and behavior. Factors like unemployment, young age and psychiatric diagnosis and severity of psychosis could be predicting factors.

Case reports have indicated that pulmonary embolism (PE) can be associated with deaths during episodes of catatonia. A 15-year death registry in Kentucky state psychiatric hospitals was reviewed for deaths during episodes of catatonia. From 2002 to May of 2016, reports of 96 deaths at these state psychiatric hospitals were found and reviewed by the state mortality committee. The charts of the identified catatonic patients were thoroughly reviewed. All 6 deaths occurred during episodes of what Fink and Taylor would call retarded catatonia and Ungvari would call acute stuporous catatonia. The deaths were sudden and appeared to be explained by PE. They accounted for 6% (6/96) of the state hospital deaths. Moreover, they explained 32% (6/19) of the deaths that the committee considered preventable at some level, making pulmonary embolism by far the most important cause of preventable deaths. Catatonia diagnosis and treatment were far from optimal. The stupor in these 6 patients lasted many weeks with a median duration of catatonic symptoms while hospitalized of 45 days in the total sample and 75 days in four patients who died suddenly. If replicated in other mortality databases from other states or countries, two lessons in prevention of these PE deaths in catatonia would be the urgent needs to: 1) improve the skills of clinicians (psychiatrists and internists) for diagnosing and treating stuporous episodes of catatonia and 2) quickly and aggressively treat stuporous episodes of catatonia.

Rationale: People diagnosed with a mental disorder are highly discriminated against, and when they internalize the social stigma they suffer severe consequences which have been associated with greater symptomatology and reduced recovery. This research was carried out in order to develop a predictive model about how discrimination contributes to subjective well-being (positive and negative affects experienced) by means of internalization of stigma (alienation, stereotype endorsement and social withdrawal) and deterioration of positive self-concept (self-esteem and self-efficacy).

Method: We conducted a cross-sectional research design. We used Partial Least Squares (PLS) modelling to analyze the data from 94 Spanish participants diagnosed with a mental disorder.

Results: A differential effect of blatant and subtle discrimination is found. Both internalized stigma and positive self-concept play a central role in the effects of discrimination on subjective well-being. Internalized stigma contributes to the explained variance of negative and positive affect, while positive self-concept contributes mainly to explain changes in positive affect.

Conclusions: Positive self-concept protects the person from the harm that stigma may cause on his well-being. It especially protects positive affect, which we propose is an important resource in the recovery process. These findings have clinical and research implications.

Background: Sensory distortions of body image commonly occur during migraine, seizures, nondominant cortical infarcts and hallucinogen abuse.

Methods: We report the case of a 30-year-old woman with paranoid schizophrenia presenting with postpartum onset multimodal sensory distortions in the absence of any neurological disorders or substance use.

Results: Her symptoms involved persistent facial/body metamorphopsia (distorted images) and vocal paracousis (distorted voices), in the absence of visual hallucinations, illusions or agnosia. Neuropsychological assessments revealed deficits on visual processing tasks. Neuroimaging, electroencephalography and ophthalmological evaluation revealed no abnormalities. The multimodal sensory distortions responded to antipsychotic treatment, paralleling improvement in other schizophrenia psychopathology, over a period of one month.

Conclusions: Prominent and persistent multimodal sensory distortions like metamorphopsia and paracousis in the presence of psychotic symptoms warrant a detailed neurological and general medical work-up. These symptoms presenting in the absence of neurological or substance use disorders may be a component of schizophrenia.

Background: Paranoia is a disruptive belief that can vary across a continuum, ranging from persecutory delusions presented in clinical settings to paranoid cognitions that are highly prevalent in the general population. The literature suggests that paranoid thoughts derive from the activation of a paranoid schema or information processing biases that can be sensitive to socially ambiguous stimuli and influence the processing of threatening situations.

Methods: Four groups (schizophrenic participants in active psychotic phases, n=61; stable participants in remission, n=30; participants' relatives, n=32; and, healthy controls, n=64) were assessed with self-report questionnaires to determine how the reactions to paranoia of clinical patients differ from healthy individuals. Cognitive, emotional and behavioral dimensions of their reactions to these paranoid thoughts were examined.

Results: Paranoid individuals were present in all groups. Most participants referred to the rejection by others as an important trigger of paranoid ideations, while active psychotics were unable to identify triggering situations to their thoughts and reactions. This may be a determinant to the different reactions and the different degree of invalidation caused by paranoid thoughts observed across groups.

Conclusions: Clinical and nonclinical expressions of paranoid ideations differ in terms of their cognitive, emotional and behavioral components. It is suggested that, in socially ambiguous situations, paranoid participants (presenting lower thresholds of paranoid schema activation) lose the opportunity to disconfirm their paranoid beliefs by resourcing to more maladaptive coping strategies. Consequently, by dwelling on these thoughts, the amount of time spent thinking about their condition and the disability related to the disease increases.